Elephantiasis Nostras Verrucosa

76-year-old male skilled nursing facility resident with a history of bilateral, deep venous thromboses of his lower extremities, chronic venous stasis ulceration of his legs and recurrent episodes of lower extremity bacterial cellulitis was admitted with chronic, bilateral lower extremity woody induration and papillomatosis resembling elephantiasis. He had no exposures to Filarial infection, normal thyroid function, no history of diabetes, congestive heart failure or malignancy. A clinical diagnosis of elephantiasis nostras verrucosa was made. This rare chronic condition is cause by chronic lymphatic inflammation and fibrosis. He was treated with topical retinoids, pneumatic compression and bandages.